Minimum grade required: B, excluding Year 1 & Year 2 students. If you are interested in more than one course, please rank the courses according to your preference (1) 1st choice (2) 2nd choice (3) 3rd choice.

Semester*:

Fall

Winter

Sprummer

Course Number:

Name*:

Date of Birth*:

**Please enter Date of Birth dd-mm-yy**

WLU ID Number*:

Social Insurance Number*:

Home Address

Street*:

City*:

Province*:

Postal Code*:

Phone number*:

Address in September (if known)

Street:

City:

Province:

Postal Code:

Phone number:

'mylaurier' e-mail address *:

Academic Level in September*:

2nd year

3rd year

4th year

Graduate student (MSc)

Masters Degree (PhD)

TO BE COMPLETED BY THE BIOLOGY DEPARTMENT

Academic Level:

Account #:

Course Number(s) - Sept - Dec:

Course Number(s) Jan - Apr:

Course Number(s) May - Aug:

Lab Section(s):

No. hours/week:

No. hours/term:

Hourly Wage:

Stipend/term:

updated July 06/15

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